2015 Julie Wallace Award - Dr Aoife Ryan

We are delighted to announce that Dr Aoife Ryan from University College Cork is the 2015 winner of our Julie Wallace Award. Dr Ryan will be presented with her award on 18 June at our Nutrition at Key Life Stages conference in Cork, Ireland. Attendees will have the chance to listen to her deliver the Julie Wallace Award Lecture, titled ‘Cancer-associated malnutrition, cachexia and sarcopenia: The skeleton in the hospital closet 40 years later’.

We interviewed Dr Ryan about her career and research interests ahead of the conference.

Q: You began your career as a dietitian. How did you become involved in cancer-related malnutrition?

I began my career as a locum dietitian in St. James’s hospital in Dublin where I would rotate around medical specialties covering for colleagues on leave. This was a great start as I got exposure to pretty much the entire hospital. I fast realised my favourite area of dietetics was GI surgery. I loved the challenge of dealing with patients who had very sick guts. I spent seven years working in a surgical unit which did a lot of major GI cancer surgery. I was fortunate that when I graduated I won a post graduate scholarship, which meant I had to start research within three years of my BSc. I asked Professor John Reynolds if I could do research with him. He is professor of surgery at TCD and an upper Gastrointestinal surgeon. Much of his own post graduate research had been in gut barrier function in malnourished patients and he has won ASPEN awards for this work. It was a perfect fit for me to have a supervisor who was a surgeon with such a huge knowledge base on nutrition. I left SJH in 2007 and moved to New York with my husband who is a medical oncologist. We returned to Ireland in 2011 and because he is a consultant in the two university teaching hospitals in Cork it has meant that it has been incredibly easy to set up a research programme in UCC. Most of the research we now do is in medical oncology, although I am still collaborating with Prof Reynolds in Dublin on a PRCT in surgical oncology patients. So my interest in nutrition spans both surgical and medical oncology and investigates how nutrition impacts on outcomes.

Q: Why did you apply for the Julie Wallace Award and what does winning the award mean to you personally?

I am a huge admirer of the work of Prof Julie Wallace. She was just a few years older than me when she passed away, yet she lead such an active research programme and had published an incredible amount of work. It is a huge honour to be receiving this award and I am incredibly grateful.

Q: Your research title, ‘The skeleton in the hospital closet 40 years later’ is particularly interesting, why did you choose this title?

Much of the research we have done in Cork over the last four years has unearthed the major issue of wasting of muscle in cancer patients. Obesity is a huge risk factor for cancer and I spent a lot of my PhD looking at this association. When cancer patients are diagnosed they often have normal BMIs and many (>50%) are overweight and obese. Underneath all this adipose tissue can be a situation of extreme muscle wasting, which is driven by the host response to the tumour. So I decided to use this title, as I think the issue of malnutrition in oncology is just as prevalent as it was 40 years ago, but in 2015 a lot health care professionals are unaware of it due to the obesity epidemic.

Q: Does this mean that we do not know any more about the impact of nutrition on cancer than we did 40 years ago?

I think we are learning fast thanks to the advent of gold standard body composition techniques such as Computed Tomography (CT), which are freely available in oncology. However this method of assessment still remains very much in the research setting. The obesity epidemic means more people develop cancer, more cancer patients are have BMIs>25 but depending on cancer site upwards of 60% of them can have severe muscle wasting. We are only beginning to understand the devastating consequences this can have on how they tolerate treatment, how it impacts on their quality of life and how it shortens their survival. During the Nutrition at Key Life Stages conference we will hear form Prof Carla Prado from Alberta in Canada, who has very much pioneered the field of sarcopenia and toxicity to chemotherapy. I believe (and hope) that this important research will challenge the way doctors think about malnutrition, and hopefully lead them to clinical trials where chemotherapy is based on body composition versus flat dosing or dosing according to body surface area.

Q: Has research in the past 40 years into the effects of malnutrition on disease improved the prognosis in cancer patients?

To answer this question honestly, cancer cachexia has suffered more therapeutic nihilism than any other symptom in palliative care, because as yet we do not have any licenced drug to treat it, we are unable to reverse the metabolic consequences of wasting with nutrition alone, and, we do not have any medications to safely stimulate appetite. We know a great deal about the very negative consequences of weight loss in cancer patients, but without an effective treatment the prognosis remains poor. There are new drugs on the horizon (currently in phase III clinical trials) and I am excited to be taking part in the MENAC trial, which is an international trial in lung and pancreatic cancer starting shortly in many international sites. This trial will address multimodal therapies (exercise, nutrition and anti-inflammatory drugs) to prevent cachexia. Depending on the results of these trials the future will look more promising.

About the Julie Wallace award:
The award marks the memory of Professor Julie Wallace from the Northern Ireland Centre for Food and Health (NICHE), University of Ulster, who passed away on 7 February 2012 following a short illness, aged only 40. In addition to an outstanding academic career, Professor Wallace was passionate about supporting, nurturing and promoting early career researchers. Our Julie Wallace award therefore aims to recognise outstanding early career researchers in the field of nutrition. To find out more, click here.